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Ice Storm Hits L.A. Health Authority Idea : County's wary supervisors should embrace tested proposal

December 17, 1995

Must there be a crisis before the Los Angeles County Board of Supervisors entertains creative ideas? It appears so, judging from its icy response to a proposal for a health authority--a panel to help restructure the besieged Department of Health Services. A majority of the five supervisors expressed eitls--would manage the reforms that are so desperately needed in the huge system.

The supervisors, of course, are worried about losing power and control. But they saw no problem in seeking outside counsel last summer when the system was near collapse. They created a health care task force and appointed Margolin, a lawyer and former assemblyman, as its head. Margolin went on to engineer a plan to restructure and revive the system. The Clinton administration backed the plan and gave the county a Medicaid waiver and $364 million to keep its clinics and hospitals open. That scheme bought time, but it did not remove the need for major reform--reconfiguring the system from costly hospital-based treatment to economical outpatient care.

STORM COVER: Change at the top came with the recent hiring of outsider Mark Finucane as director of the Department of Health Services. Now Finucane's department must be shielded from the political winds of the Board of Supervisors. A semiautonomous health authority, as proposed, would serve that purpose and would possess the expertise--knowledge that the supervisors lack--to propel restructuring.

Some changes are underway. A number of county clinics are being privatized, reducing the drain on government coffers. Under consideration are more public-private health partnerships for county facilities and changes in the size and configuration of the massive County-USC Medical Center. There is far to go. At a state hearing on Friday, L.A. health administrators questioned whether the county will carry out the reforms. The supervisors could be a roadblock.

Traditionally, the supervisors have approached health care from parochial perspectives. Supervisorial district interests often have conflicted with oversight responsibilities. For instance, the desire to keep constituents in health system jobs has sometimes taken priority over efficient and cost-effective delivery of care.

WHO'S GOT A HOSPITAL?: That tendency seemed to be reflected in the board's wary response to Margolin's proposal for a health authority.

Only Supervisor Zev Yaroslavsky, whose district has no public hospital, strongly favored the idea. Yvonne Brathwaite Burke, whose district has two public hospitals, backed the proposal in concept but raised a significant question about budget authority: Who would rule on expenditures--the supervisors or the health authority? Mike Antonovich and Deane Dana, who each have public hospitals in their districts, flatly opposed the plan. Gloria Molina, whose district includes County-USC, was open to the concept. A public hearing on the Margolin report is scheduled for February.

Finucane, who assumes his new post Jan. 15, will face daunting challenges such as closing a $199-million budget gap for fiscal 1996-97 and dealing with possible cuts in federal funding. The crisis in county health care will require all his skills, plus innovative approaches across the range of county leadership.

Margolin's idea for a health authority, a structure used elsewhere in the country to shield health care decisions from politics, is a good one. All of the supervisors should embrace it.

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